Aliva De1, Temima Waltuch2, Nathan J Gonik3,4, Ngoc Nguyen-Famulare5,6, Hiren Muzumdar1,7, John P Bent3, Carmen R Isasi8, Sanghun Sin1, Raanan Arens1. 1. Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York. 2. Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York. 3. Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. 4. CS Mott Children's Hospital, University of Michigan, Anne Arbor, Michigan. 5. Department of Anesthesiology, Montefiore Medical Center, Bronx, New York. 6. Department of Anesthesiology, Winthrop-University Hospital, Mineola, New York. 7. Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 8. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York.
Abstract
STUDY OBJECTIVES: There are few studies measuring postoperative respiratory complications in obese children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obese children with OSA for their respiratory characteristics and sleep architecture on the night of AT. METHODS: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obese children between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. RESULTS: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentation-arousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). CONCLUSIONS: Obese children undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. COMMENTARY: A commentary on this article appears in this issue on page 775.
STUDY OBJECTIVES: There are few studies measuring postoperative respiratory complications in obesechildren with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (AT). These complications are further compounded by perioperative medications. Our objective was to study obesechildren with OSA for their respiratory characteristics and sleep architecture on the night of AT. METHODS: This was a prospective study at a tertiary pediatric hospital between January 2009-February 2012. Twenty obesechildren between 8-17 years of age with OSA and adenotonsillar hypertrophy were recruited. Patients underwent baseline polysomnography (PSG) and AT with or without additional debulking procedures, followed by a second PSG on the night of surgery. Demographic and clinical variables, surgical details, perioperative anesthetics and analgesics, and PSG respiratory and sleep architecture parameters were recorded. Statistical tests included Pearson correlation coefficient for correlation between continuous variables and chi-square and Wilcoxon rank-sum tests for differences between groups. RESULTS: Baseline PSG showed OSA with mean obstructive apnea-hypopnea index (oAHI) 27.1 ± 22.9, SpO2 nadir 80.1 ± 7.9%, and sleep fragmentation-arousal index 25.5 ± 22.0. Postoperatively, 85% of patients had abnormal sleep studies similar to baseline, with postoperative oAHI 27.0 ± 34.3 (P = .204), SpO2 nadir, 82.0 ± 8.7% (P = .462), and arousal index, 24.3 ± 24.0 (P = .295). Sleep architecture was abnormal after surgery, showing a significant decrease in REM sleep (P = .003), and a corresponding increase in N2 (P = .017). CONCLUSIONS:Obesechildren undergoing AT for OSA are at increased risk for residual OSA on the night of surgery. Special considerations should be taken for postoperative monitoring and treatment of these children. COMMENTARY: A commentary on this article appears in this issue on page 775.
Authors: Jeffrey B Gross; Kenneth L Bachenberg; Jonathan L Benumof; Robert A Caplan; Richard T Connis; Charles J Coté; David G Nickinovich; Vivek Prachand; Denham S Ward; Edward M Weaver; Lawrence Ydens; Song Yu Journal: Anesthesiology Date: 2006-05 Impact factor: 7.892
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Authors: Ronald D Chervin; Seockhoon Chung; Louise M O'Brien; Timothy F Hoban; Susan L Garetz; Deborah L Ruzicka; Kenneth E Guire; Elise K Hodges; Barbara T Felt; Bruno J Giordani; James E Dillon Journal: Sleep Med Date: 2014-06-06 Impact factor: 3.492